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Post by shrewsace on Feb 21, 2011 20:38:03 GMT 1
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Post by SeanBroseley on Feb 21, 2011 23:25:56 GMT 1
And what it creates is private monopolies earning monopoly profits. And that doesn't need justifying apparently. And even if you are dissatisfied with the service to the extent that you involve your MP your MP gets fobbed off by the Chief Exec of the said organisation, and you can't touch them because the organisation won a tendering process and so have a guaranteed fiefdom for 5, 10, 15 years. If something is a natural monopoly then it needs to be in the public sector or at the very least run on behalf of the state by non-profit organisations that are open to scrutiny and appeal in individual cases.
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Post by Deleted on Feb 21, 2011 23:27:59 GMT 1
Agreed Sean - follows on nicely from the debate on the railways a couple of weeks ago about natural monoplies.
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Post by SeanBroseley on Feb 21, 2011 23:31:45 GMT 1
And also follows on from a discussion currently taking place on radio 4. The health secretary is arguing that raising the real price of alcohol back to where it was 30 years ago will not affect alcohol consumption. So the price mechanism doesn't work? But you want to privatise the NHS.
Left wing humour. that's all.
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Post by Deleted on Feb 21, 2011 23:45:09 GMT 1
Unbelievable stuff, and very worrying. I can see the so called "private providers" bidding against each other to win contracts with the so called saving being passed indirectly onto the "service user". In other words, they pay less to win the contract but provide a cheaper service to maximise profits. Its what this lot do. And if you are lucky enough to get yourself a position with the new privately funded service provider don't expect to be well paid for your toil, cos that also cuts into the profit margin. And , just to make you feel even better, all profits will be secreted away into an off shore, tax free haven. Forget the marches, lets start a crusade.
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Post by jamo on Feb 22, 2011 8:23:15 GMT 1
Forget the marches, lets start a crusade. Easy to talk on a messageboard, were you at the march on saturday ?...probably not.
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Post by shrewinjapan on Feb 22, 2011 9:26:15 GMT 1
If the industry I work in is anything to go by, tendering for public contracts by private companies results in savings to the public purse, but only because of cut-throat bidding at extremely tight margins that result in corner-cutting and poor service and poorly paid, poorly motivated workers with little job security (that's me!). Believe me, it's not a pretty picture!
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Post by Shrewed on Feb 22, 2011 9:27:33 GMT 1
At last we see the real face of the sons of Thatcher, after policies to increase unemployment, reduce taxes for the fat cats, and reduce benefits for the poorest in the country we now have final nail in the coffin for Society the sell off of all the services that people depend on, education of the young and care of the sick and elderly being just two of their targets.
When I read Camerons pronouncement I looked back at the 80's and started to wonder where were the successes of Thatcher's privatisation, I am sure there were some but I do struggle to think of ones which are not now foreign owned near monopolies making large profits or where the service we receive is better than it was pre-privitisation.
Has the consumer benefited from any of these organisations being privitised:
Water Electricity Gas Railways Airports
Are our hospitals cleaner as a result of competitive tendering.
The public sector is not perfect by any means but it does provide essential services. It needs to be managed better by professionals who are paid the going rate for the responsibility and size of the task.
We now have a coalition that knows the cost of everything and the value of nothing.
In 1997 the fabric of the country had been severely damaged after 17 years of Thatcher and Major it now looks like the 3 stooges are aiming to complete the job in the next 4 years.
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Post by stfcfan87 on Feb 22, 2011 11:54:07 GMT 1
PCT's moved into a commissioning role a few years ago, with the idea being that they would know what services they needed, and would write the contracts that would be issued stating exactly what needed to be provided and the level of cover, and then providers such as hospitals or gp services would have to meet the details of that contract. Where they didn't e.g. fell below the waiting times etc, the contract could be ended and go out to a different supplier. I don't have that much of a problem with that in principle, as often there can be services by providers that simply don't do what they should - happens more often than you think - and this provided a mechanism for making them up to standard and at least gives some power to the commissioners to ensure the provider makes neccessary changes.
The problem with it though is that it works best where there are lots of possible providers - i.e. big cities like London, Birmingham etc. In those cases the PCTs would be able to say if one hospital isn't providing adequate care, then they could transfer services to a different one. The trouble is in remote areas like Shropshire there just isn't the choice. If SATH's services don't perform then its not like they can go elsewhere.
The other difficulty is when you could get private companies involved that may only do the profitable elements of the health service - but what about the other elements that are perhaps not so profitable, for example (just off the top of my head) stroke patients and the like i.e. patients that could be in hospitals for an indefinate period. If the hospitals don't get the money for the profitable jobs, then they can't fund the less profitable jobs.
The trouble is now the government's going to be getting rid of PCTs, who at least have a distant, impartial view, and are instead going with GP consortia - now as GPs could be a provider too, that could create a conflict of interests, plus a lot of GPs can be very pally with consultants, and additionally GPs aren't actually too hot on looking at overall population needs (just their own patients/practice), nor on writing contracts etc.
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Post by southshropblue on Feb 22, 2011 13:25:43 GMT 1
And what it creates is private monopolies earning monopoly profits. And that doesn't need justifying apparently. And even if you are dissatisfied with the service to the extent that you involve your MP your MP gets fobbed off by the Chief Exec of the said organisation, and you can't touch them because the organisation won a tendering process and so have a guaranteed fiefdom for 5, 10, 15 years. If something is a natural monopoly then it needs to be in the public sector or at the very least run on behalf of the state by non-profit organisations that are open to scrutiny and appeal in individual cases. firstly privatisation has been creeping up for years never faster than when Labour was in power 97-2010- It is also no secret that Tony Blair wanted to go much further than he dared with reform My own view is that we are very complacent about the state of our public services and they often seem to be run for the sake of the employees rather than the service users- Complaining is a thankless and often fruitless tasks Labour put huge amounts of money into them and although there was some improvement it was small compared to amount of extra money put in I think Cameron's ideas are worth a go
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Post by ratcliffesghost on Feb 22, 2011 13:31:38 GMT 1
The trouble is now the government's going to be getting rid of PCTs, who at least have a distant, impartial view, and are instead going with GP consortia - now as GPs could be a provider too, that could create a conflict of interests, plus a lot of GPs can be very pally with consultants, and additionally GPs aren't actually too hot on looking at overall population needs (just their own patients/practice), nor on writing contracts etc. You're assuming there that GP's will want to refer you on - it will be in their interests financially not to!
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Post by southshropblue on Feb 22, 2011 14:02:24 GMT 1
The trouble is now the government's going to be getting rid of PCTs, who at least have a distant, impartial view, and are instead going with GP consortia - now as GPs could be a provider too, that could create a conflict of interests, plus a lot of GPs can be very pally with consultants, and additionally GPs aren't actually too hot on looking at overall population needs (just their own patients/practice), nor on writing contracts etc. You're assuming there that GP's will want to refer you on - it will be in their interests financially not to! That is one way of seeing it -the other way is that In stripping out a layer of beaurocracy money is saved which can be invested in patient care and decisions made not by distant people but by people who know their patients. It is an interesting assertion that GP's arent good at looking after general population needs any evidence? I am not sure these changes will work I just think they are worth a go
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Post by WindsorShrew on Feb 22, 2011 14:10:54 GMT 1
With regard to the Health Service I feel that of course it needs to be updated, I don't at present see it as value for money in terms of the amount of money pumped in. Thus it needs to evolve to best meet the requirements of todays population.
That said I firmly believe the Health service should remain in the control of the state, the quantum of patients against profit does not bear thinking about.
I also feel that the monitoring of Hospital procedures should be tightened in particular with regard to financial wastage and the procurement of drugs.
Also I do feel that those who participate in private schemes should be recognized with a benefit in kind with regard to tax paid (Nat Ins).
As a moderate right winger I would oppose any closure to Departments in the Princess Royal and dare say would even march for the cause.
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Post by SeanBroseley on Feb 22, 2011 14:11:21 GMT 1
It's not a question of being worth a go it is a matter of having to do this as this government pursues the agenda of the reducing the effective rates of tax on large corporations to less than 10%.
Monopolies generating monopoly profits that get lightly taxed.
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Post by stfcfan87 on Feb 22, 2011 14:18:42 GMT 1
You're assuming there that GP's will want to refer you on - it will be in their interests financially not to! That is one way of seeing it -the other way is that In stripping out a layer of beaurocracy money is saved which can be invested in patient care and decisions made not by distant people but by people who know their patients. It is an interesting assertion that GP's arent good at looking after general population needs any evidence? I am not sure these changes will work I just think they are worth a go Well that's one point I meant ghost - it could be they don't refer them on or they refer them to themselves.... No evidence regarding my post Southshropblue, but it's going to be a vastly different thing for GPs. At present if a patient comes to them in need of a referral or tests they can pass them on so to speak and then have little else to do until such time that the patient is seen. At present GPs will only be aware of the health needs in their practice / area - a GP from Bridgnorth won't for example have knowledge of health needs in Oswestry (a very different population). So to assess this, then set up and provide services considering the whole population is going to be quite a change for GPs on top of them actually seeing patients. But if GPs are the ones in charge of deciding which services get funded or not, then that's certainly going to change their relationship with their patients isn't it. If a service doesn't function sufficiently or is cut, it's now going to be the GPs themselves who are going to have to explain to their own patients why. If a patient has a complaint, then they're going to have to complain to their own doctor. And if the GPs need experts to do this type of work, then I'm failing to see how it's going to remove the layers of beaurocracy.
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Post by bananafeet on Feb 22, 2011 14:20:59 GMT 1
You're assuming there that GP's will want to refer you on - it will be in their interests financially not to! That is one way of seeing it -the other way is that In stripping out a layer of beaurocracy money is saved which can be invested in patient care and decisions made not by distant people but by people who know their patients. It is an interesting assertion that GP's arent good at looking after general population needs any evidence? I am not sure these changes will work I just think they are worth a go Most lavish GP Practice extensions and refurbishments can be traced back to the last time this was tried - it was called "GP Fundholding" then and they were given 2 years to spend any budget savings - and they did to the detriment of a few peoples health
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Post by southshropblue on Feb 22, 2011 14:42:20 GMT 1
That is one way of seeing it -the other way is that In stripping out a layer of beaurocracy money is saved which can be invested in patient care and decisions made not by distant people but by people who know their patients. It is an interesting assertion that GP's arent good at looking after general population needs any evidence? I am not sure these changes will work I just think they are worth a go Well that's one point I meant ghost - it could be they don't refer them on or they refer them to themselves.... No evidence regarding my post Southshropblue, but it's going to be a vastly different thing for GPs. At present if a patient comes to them in need of a referral or tests they can pass them on so to speak and then have little else to do until such time that the patient is seen. At present GPs will only be aware of the health needs in their practice / area - a GP from Bridgnorth won't for example have knowledge of health needs in Oswestry (a very different population). So to assess this, then set up and provide services considering the whole population is going to be quite a change for GPs on top of them actually seeing patients. But if GPs are the ones in charge of deciding which services get funded or not, then that's certainly going to change their relationship with their patients isn't it. If a service doesn't function sufficiently or is cut, it's now going to be the GPs themselves who are going to have to explain to their own patients why. If a patient has a complaint, then they're going to have to complain to their own doctor. And if the GPs need experts to do this type of work, then I'm failing to see how it's going to remove the layers of beaurocracy. Thanks for all the replies Sean I think its worth a go because the status quo is not working well enough and something has to change,in my view though i admit there is no guarantee it will work stfcfan what you basically saying in your post is that the new system will make GP's more accountable Isn't that a good thing? Also my understanding (which could be wrong) is that there will be a range of GP consortia not just one for Shropshire If that is correct then they don't have to understand the whole of Shropshire just their area banana feet if your saying that under fundholding premises were improved that surely helps the patient experience as new hospitals help the patient experience Is ther any evidence treatment got worse during that time? Anyway thanks for the debate
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Post by stfcfan87 on Feb 22, 2011 16:45:01 GMT 1
No the proposal is there will be one GP consortia for Shropshire - it may not look exactly like it is now as some of the border practices may choose to go with Telford / Hereford but then again some of their practices may decide to come to Shropshire. I don't think there will be smaller ones - apart from anything else the consortia's need to be big enough to be able to negotiate contracts, to be able to fund all of the other duties they'll need to do, be able to cover other staff and potential litigation costs so having as much resources as possible would be necessary just for insurance purposes alone. And therefore they would need to take into account the entire health needs of their area, for example they'd become a big part of the current hospital debate.
And no I wasn't saying that GPs will be more accountable, if anything it could potentially mean than GPs could possibly refer to their own service rather than the better service / cheaper service (possible), and that if you as a patient had a complaint about the service you had it would be the GP you would have to go to when it could well be the GP consortia's fault, and as a patient you will now have the perception that it is actually the GPs fault as the government are presenting this idea as being the people who should be in charge of your care are the 'trusty family doctors' - what I'm saying is that this will change that trust between a patient and GP. i.e. if a patient's cancer drug can't be funded anymore then it's the GP that you see that's getting the blame - rather than them being able to put the blame on a third party organisation.
I realise in many cases it won't actually be your specific GP making the decision, however, I think the majority of patients will actually have the perception that it is. I just think it's going to really change the cosy relationship people have with their gps.
hopefully my wording makes sense!
Of course the other big thing is that GPs are simply not trained to do this - I'm unaware of massive pots of money being put aside in order to train them too, so quite how they're suddenly going to manage in addition to actually seeing patients is a mystery.
And of course this all coming at a time when public services are being cut anyway just makes no sense to me - it's not like there can be a bedding in period, as any decisions made are going to be absolutely crucial.
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Post by Deleted on Feb 22, 2011 18:09:58 GMT 1
We could just simply see an increase of what is already happening-
If in doubt refer it to social services.
Can't take the medication-refer to social services (actually a health need)
Not eat and losing substantial weight refer to social services (health need)
Serious breathing difficulties/had a fall/had an accident refer to social services (health need again)
And the end process- not enough money to keep hospital beds available, so turfing people out on the ear and expecting social service to pick up the slack when actually the person needs medical supervision.
GPs- God bless them, if you're lucky they'll refer you to social services or just about anywhere (put the blind out and see where you pin the tail..) failing that they'll tell you there's not a fat lot they can do other than prescribe you some random medication.
Reform is required, privitisation is not reform-is revolution and wrong.
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Post by Shrewed on Feb 22, 2011 18:25:41 GMT 1
Lets be totally honest here the GP's wont be the ones negotiating the contract they will set up commissioning, planning, accounting and computing functions to run the consortium. Now wait a minute that's just like the PCT's.
And when it all goes wrong it will be the doctors fault not our teflon PM
A case of rearranging the seats on the Titanic me thinks.
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islaymalt
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Post by islaymalt on Feb 22, 2011 19:59:07 GMT 1
And what it creates is private monopolies earning monopoly profits. And that doesn't need justifying apparently. And even if you are dissatisfied with the service to the extent that you involve your MP your MP gets fobbed off by the Chief Exec of the said organisation, and you can't touch them because the organisation won a tendering process and so have a guaranteed fiefdom for 5, 10, 15 years. If something is a natural monopoly then it needs to be in the public sector or at the very least run on behalf of the state by non-profit organisations that are open to scrutiny and appeal in individual cases. I think that sums it up very nicely
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Post by The Shropshire Tenor on Feb 22, 2011 20:56:37 GMT 1
Of course the other big thing is that GPs are simply not trained to do this - I'm unaware of massive pots of money being put aside in order to train them too, so quite how they're suddenly going to manage in addition to actually seeing patients is a mystery. Wont they just hire the managers made redundant by the PCT's? The problem for the politicians is that the NHS comes out very well in international comparisons, especially against the US private services that they want to introduce here. Of course, none of the millionaires in the cabinet will use the NHS anymore than they will travel standard class on the train or send their kids to state schools, so these social experiments will not affect them or their families.
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Post by Deleted on Feb 22, 2011 23:36:14 GMT 1
Forget the marches, lets start a crusade. Easy to talk on a messageboard, were you at the march on saturday ?...probably not. Wether i was at the march or not is completely irrevelant. I n your world of dis - jointed reasoning it appears that only those who marched are allowed an opinion. Hope i never catch you posting on the problems in the Middle East. By the way, did YOU actually march?
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Post by SeanBroseley on Feb 23, 2011 9:00:47 GMT 1
I understand the notion that the status quo isn't working as this is an often bandied about comment. I think we need to subject that to examination. We can do that through our own experiences, e.g. I was satisfied with the delivery of medical treatment that my mother received in 2009, but we can also test this with data. Here is something from the British Medical Journal: www.bmj.com/content/342/bmj.d566.fullI'd also want to make the point that if the reference point is outcomes in France shouldn't there also be a reference to the methods employed in France?
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Post by Deleted on Feb 23, 2011 10:12:56 GMT 1
We could just simply see an increase of what is already happening- If in doubt refer it to social services hospital admissions unit.Can't take the medication-refer to social services (actually a health need) hospital admissions unit.Not eat and losing substantial weight refer to social services (health need) hospital admissions unit.Serious breathing difficulties/had a fall/had an accident refer to social services (health need again) hospital admissions unit.And the end process- not enough money to keep hospital beds available, so turfing people out on the ear and expecting social service to pick up the slack when actually the person needs medical supervision half the hospitals beds are filled with patients awaiting care from social services as not enough money is invested as a nation in care of the growing elderly population which means that operations get cancelled and A&E waits go up.It gets to 5 in the evening and your average GP wants to go home, the gym, the golf coarse, and he/she still has 10 patients in the waiting room? - hospital admissions unit.GPs- God bless them, if you're lucky they'll refer you to either social services or just about anywhere ( hospital admissions unit.) (put the blind out and see where you pin the tail..) failing that they'll tell you there's not a fat lot they can do other than prescribe you some random medication. Reform is required, privitisation is not reform-is revolution and wrong. To be fair Rob, and i accept that this may be a matter of perspective, but i think you are hugely wide of the mark there. In fact so much so that i cant help but think i am mis reading you. I have made a few adjustments to your post to correct it to my perspective of how things work its worth also pointing out that most if not all of the examples you give in no way necessarily require a hospital admission. And that is one of the big problems with the nhs, the front line acute hospitals have become a easy dumping ground for just about everyone in the care / healthcare system. Windy, can you clarify for me what you as an individual would regard then as value for money. If you had another (God forbid) 3 heart attacks from which the nhs saved your life and got you back to a normal working life, would you regard that as value for money? :)ker
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Post by stfcfan87 on Feb 23, 2011 12:05:01 GMT 1
Of course the other big thing is that GPs are simply not trained to do this - I'm unaware of massive pots of money being put aside in order to train them too, so quite how they're suddenly going to manage in addition to actually seeing patients is a mystery. Wont they just hire the managers made redundant by the PCT's? The problem for the politicians is that the NHS comes out very well in international comparisons, especially against the US private services that they want to introduce here. Of course, none of the millionaires in the cabinet will use the NHS anymore than they will travel standard class on the train or send their kids to state schools, so these social experiments will not affect them or their families. Well yeah you'd think. So we'll spend large amounts of money making people in PCTs redundant in order to 'reduce beaurocracy' and then the same experts will be then rehired by the consortia to do the same jobs they did before but under new bosses. And that's my point, it's a complete and utter waste of money especially to do this in this economic point.
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Post by stfcfan87 on Feb 23, 2011 12:11:11 GMT 1
We could just simply see an increase of what is already happening- If in doubt refer it to social services hospital admissions unit.Can't take the medication-refer to social services (actually a health need) hospital admissions unit.Not eat and losing substantial weight refer to social services (health need) hospital admissions unit.Serious breathing difficulties/had a fall/had an accident refer to social services (health need again) hospital admissions unit.And the end process- not enough money to keep hospital beds available, so turfing people out on the ear and expecting social service to pick up the slack when actually the person needs medical supervision half the hospitals beds are filled with patients awaiting care from social services as not enough money is invested as a nation in care of the growing elderly population which means that operations get cancelled and A&E waits go up.It gets to 5 in the evening and your average GP wants to go home, the gym, the golf coarse, and he/she still has 10 patients in the waiting room? - hospital admissions unit.GPs- God bless them, if you're lucky they'll refer you to either social services or just about anywhere ( hospital admissions unit.) (put the blind out and see where you pin the tail..) failing that they'll tell you there's not a fat lot they can do other than prescribe you some random medication. Reform is required, privitisation is not reform-is revolution and wrong. To be fair Rob, and i accept that this may be a matter of perspective, but i think you are hugely wide of the mark there. In fact so much so that i cant help but think i am mis reading you. I have made a few adjustments to your post to correct it to my perspective of how things work its worth also pointing out that most if not all of the examples you give in no way necessarily require a hospital admission. And that is one of the big problems with the nhs, the front line acute hospitals have become a easy dumping ground for just about everyone in the care / healthcare system. Windy, can you clarify for me what you as an individual would regard then as value for money. If you had another (God forbid) 3 heart attacks from which the nhs saved your life and got you back to a normal working life, would you regard that as value for money? :)ker Very much agree with your post Matron. A lot of patients (particularly elderly) can be ready to go home from hospitals as there's no acute medical reason to be in an acute hospital bed anymore. However, due to social problems, i.e. not having any where to go, often because the family won't take them / allow them to go to a home, or can't decide the patient stays in. This obviously keeps a hospital bed and prevents someone else having it, meaning that eventually operations have to be cancelled because there's simply no where to go. This is hardly good for the original patient either, they're kept on a ward when they don't want to be there that's full of either similar people or sick people. And the fact that they've been left there is hardly good for their morale. Then as it's an acute hospital ward and they have no acute medical needs, it means they're not getting the care they require - e.g. rehab. This can then cause further problems down the line - for example not getting up and exercising means their limbs are weaker etc. Of course at this point the GP's hardly involved whatsoever.
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Post by Deleted on Feb 23, 2011 12:26:48 GMT 1
Different perspectives maybe Matron but I can think of three or four hospitals that we deal with who discharge elder people as a matter of course- in some cases sending them home dressed in a bed gown, in a taxi to be dropped off in the street (more often then not requiring the help of a stranger in order to get into their house)in the evening. No notice give by the ward to social services.
The amount of referals we get from GPS which are health issues and require either medical intervention in the form of a hospital bed or district nurse is rediculess.
Hospitals refusing to confirm someone is admitted despite being in a hospital bed for two days and nights because a place on an "appropriate ward" has not ben allocated? Either someone is admitted or they are not, and if they are recieving treatment and lying in a hospital bed surely they are admitted.
One of the issues (beside GPs just refering randomly to ss) we have is of the hospital discharging people before they are ready, the family don't have sufficient time to organise arrangements, the hospital fail to issue section 2's (proposed discharge date) and then just randomly upload a section 5 (date of discharge) without formally notifying the social services team within the hospital-who are expected to assess elderly patient before they get discharged so that care arrangements can be organised.
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Post by Shrewed on Feb 23, 2011 14:32:55 GMT 1
Well yeah you'd think. So we'll spend large amounts of money making people in PCTs redundant in order to 'reduce beaurocracy' and then the same experts will be then rehired by the consortia to do the same jobs they did before but under new bosses. And that's my point, it's a complete and utter waste of money especially to do this in this economic point. But when they are rehired their terms of employment will not be the same as while they were employed by the NHS. Lower wages, less holidays poorer pension etc. Then the three stooges will say we have got rid of loads of bureacrats from the NHS. Just like today there is the news that there are nearly 2500 more doctors since last may and there was me thinking it takes 7 years to train a doctor. I wonder where they all came from!!! www.bbc.co.uk/news/uk-england-london-12548153As I said rearranging the seats on the Titanic
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Post by southshropblue on Feb 23, 2011 17:21:54 GMT 1
I understand the notion that the status quo isn't working as this is an often bandied about comment. I think we need to subject that to examination. We can do that through our own experiences, e.g. I was satisfied with the delivery of medical treatment that my mother received in 2009, but we can also test this with data. Here is something from the British Medical Journal: www.bmj.com/content/342/bmj.d566.fullI'd also want to make the point that if the reference point is outcomes in France shouldn't there also be a reference to the methods employed in France? Thanks Sean but because the comment is bandied about doesn't make it untrue I agree that comparing health services is very difficult indeed and we can find loads of articles on either side France do seem to get better outcomes but also spend a bit more I think For work reasons I visit hospitals quite a lot and there is no doubt some gifted people working in the NHS who work very hard but it is hard to avoid the conclusion it is over managed and the management often gets in the way of health care rather than aiding it Yes people will employ former PCT employees but probably not so many In the last month I have seen people in hospital having awesome care and others getting very poor treatment my observation is that poor treatment is increasing slowly in frequency but am happyu to admit this is based on personal observation though quite a lot of it
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